Provider Demographics
NPI:1609921147
Name:MILLER, CAROL T (APRN-PMH, BC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN-PMH, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4931
Mailing Address - Country:US
Mailing Address - Phone:301-663-1683
Mailing Address - Fax:
Practice Address - Street 1:340 PARK AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4931
Practice Address - Country:US
Practice Address - Phone:301-633-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134051163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
131985OtherMEDICARE PTAN